SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Despite the growth in health promotion programs for able-bodied people, very little effort has been devoted to developing programs for people with physical and cognitive disabilities. Programs for people with disabilities must be developed with full recognition of limitations caused by both the primary and secondary disability.
The concept of transcultural nursing is relatively new to the nursing literature. It had been less than 30 years since Madeleine Leininger first began to develop a theory of transcultural nursing as part of a doctoral study in anthropology. Much has changed in that time, and nursing staff development and inservice educators need to provide educational offerings within a multicultural context in a timely manner. Cultural diversity is the standard in the mid-1990s, and those nursing staff development programs that are sensitive to this fact produce employees with advantages over those from settings that do not prepare staff for practice in a constantly changing world. This annotated bibliography about transcultural nursing details key references for staff development and inservice programs. It is not intended as an exhaustive review but rather focuses on the most relevant, timely, and useful of the ever increasing number of publications concerning this important subject. Six major books and four of the most pertinent recent journal articles are included. Conclusions and implications for nursing staff educators are offered.
Leaders of geriatric programs at academic health centers (AHCs) face several challenges in seeking support for clinical program development. These challenges relate to how revenues from Medicare activities flow within AHCs. Typically, clinical departments such as the Department of Medicine see a very small proportion of total AHC Medicare revenue and frequently experience losses on their Medicare activities. In contrast, hospitals in AHCs see the bulk of the revenues and typically experience substantial profits. This article examines this situation in some detail, with specific examples from AHCs with which the author has consulted.The unique effect of Medicare revenue on AHCs requires the geriatric leader to identify who gains and who loses from Medicare activity within his or her AHC and to seek support for geriatric programs based on that analysis.
Stable isotope labeled (SIL) drug methods are compared with standard methods for performing early (phases I and IIa) drug development studies (mass balance, bioavailability, single-dose volunteer and patient, multiple-dose volunteer and patient). SIL methods offer considerable reduction in the cost (> 50%) and number of subjects (67%) required for bioavailability and multiple-dose patient studies. Moreover, a complete early drug development program is described for optimally combining SIL and standard studies, which can reduce cost by 23% and number of subjects by 36% compared with a program using standard methods. These reductions should result in development time savings of at least one year.
National attention has been drawn to the near epidemic rates of teen-age pregnancy in this country, with greater psychological understanding of this problem cited as a research need. This paper reviews available literature on teen contraceptive compliance with particular focus on the development of self-regulation. In this first section, programs designed to enhance teens' choice and use of birth control are reviewed, with specific attention given to emerging issues and methodological concerns. In the second section, studies that examine factors predictive of contraceptive use in teen-age girls are discussed. This literature is grouped according to three conceptual systems: medical perspectives, behavioral theory, and self-regulation and self-control approaches. A summary is presented, specifying ways in which conceptually based research findings can assist in program development to address the problem of teen pregnancy.
The inevitable conclusion is that the availability of biological warfare agents and supporting technologic infrastructure, coupled with the fact that there are many people motivated to do harm to the United States, means that America must be prepared to defend her homeland against biological agents. Some have argued to the contrary, that the threat and risks from a biological weapon attack are not to be considered serious, because [39]: They've not been used yet on a large scale so they probably won't be in the near future. Their use is so morally repugnant that they probably won't be used at all. The technologic hurdles associated with isolating, growing, purifying, weaponizing, and disseminating adequate quantities of pathologic agents are so high that only the most advanced laboratories could attempt the process. Similar to a 'nuclear winter,' the aftermath of a biological attack is so unthinkable that none would attempt it. Unfortunately, the trends associated with biotechnology globalization, terrorist group dynamics, and global/regional politics render these beliefs untenable and inappropriate, as recent events have underscored. To that end, the United States has accelerated its program of defense against biological weapons, as it must. Biological weapons are such dreadful weapons of uniqueness and complexity that a specific defense strategy is paramount. Elements of this program include pharmaceutical stockpiles, heightened surveillance systems, energized vaccine development programs, and comprehensive training initiatives. Although the depth and breadth of these efforts are unprecedented, above all these efforts is the absolute necessity for medical and public health care professionals to be educated and actively involved. These professionals are the sine qua non of future defensive readiness. This is just the start; unfortunately, there is no end yet in sight.
As we enter a new century and millennium, departments of obstetrics and gynaecology in American medical schools face a number of challenges. Of primary concern among these is the relative dearth of physician-scientists to explore and connect the basic mechanisms and clinical aspects of the diseases of women. This report reviews some aspects of three programmes designed to educate such investigators: The Reproductive Scientist Development Program, The American Gynecological and Obstetrical Society--American Association of Obstetricians and Gynecologists Foundation Fellowship Program and the Women's Reproductive Health Research Career Development Centers. Based on a decade of experience with the first two of these programmes, the prospects for the relatively new third programme are promising. Nonetheless, the need for and opportunities for obstetrician-gynaecologist reproductive scientists far exceed the supply.
This paper describes and discusses for microscopists and spectroscopists the choice of computer equipment and the design of programs used in the Denver Universal Microspectroradiometer (DUM). This instrument is an accurate computerized photon-counting microspectrophotometer, microspectrofluorimeter and microrefractometer. The computer is used to control the operation of the system, to acquire radiometric data of various kinds, and to reduce, analyse and output the data in a readily usable form. Since the radiometer was designed to carry out many kinds of measurements in a variety of micro- and macroscopic specimens, and since different methods of microscopy or spectroscopy have to be combined in various ways fro the study of any one specimen, no single master-program could fulfill efficiently all foreseeable requirements. Therefore, the programming developed is interactive, modular, hierarchical and hybrid. Modular interactive programming makes it possible for almost any kind of main program, applicable to almost any kind of measurement, to be assembled quickly from a collection of hierarchical subroutines. Main programs are short and composed mainly of Fortran statements calling subroutines; subroutines, in turn, automatically call other subroutines over many levels. The subroutines are independently written and optimized for maximum operational efficiency in the computer system used, or for maximum ease of transfer to other systems. This approach to programming enables someone unfamiliar with computer languages to operate the radiometric system from the console of the CRT terminal. The writing of new main programs, by linking groups of existing subroutines, requires only a minimum acquaintance with Fortran; only the writing and revision of subroutines requires programming experience. Differences and similarities in the method of computer operation between the present system and other computerized radiometers are briefly discussed.
To date, relatively few programs have been evaluated that were designed to affect the clinical practice patterns of primary care physicians who treat patients with hypertension. In particular, studies that have evaluated blood pressure control as a clinical outcome before and after an intervention are lacking. The Hypertension Management Program, developed by Applied Health Outcomes, is a quality improvement program designed to improve the medical management of hypertension in population-based health care settings. This program is in the process of continuing to collect baseline data from health maintenance organizations, conducting physician-focused interventions designed for improving clinical care, and collecting postintervention data between 6 and 12 months after the intervention is completed to determine its effect. The authors present the rationale for conducting large-scale hypertension management programs that measure outcomes, as well as preliminary baseline and postintervention data from the Hypertension Management Program, based on a current database of more than 1.9 million individuals enrolled in eight health care plans.
The bacterial genus Streptomyces forms chains of spores by septation at intervals in aerial hyphae and subsequent maturation on solid medium. Substrate hyphae undergo extensive lysis, liberating nutrients on which aerial hyphae develop. Some mutant strains, however, ectopically form spores by septation in substrate hyphae on solid medium or in vegetative hyphae in liquid medium, which suggests that all hyphae have the potential to differentiate into spores. A Streptomyces griseus mutant strain NP4, which has a mutation in the regulatory system for an ATP-binding cassette (ABC) transporter gene, forms ectopic spores in substrate hyphae only on glucose-containing medium. In addition, overexpression of a substrate-binding protein of the ABC transporter in the wild-type strain causes ectopic septation in very young substrate hyphae and subsequent sporulation in response to glucose. These ectopic spores germinate normally. The ectopic sporulation is independent of A-factor, a microbial hormone that determines the timing of aerial mycelium formation during normal development. Thus, substrate hyphae of Streptomyces have a potential to develop into spores without formation of aerial hyphae. For programmed development, therefore, the strict repression of septum formation in substrate mycelium should be necessary, as well as the positive signal relay leading to aerial mycelium formation followed by septation and sporulation.
The importance of health promotion is recognized throughout the nation. The Surgeon General's report of 1980, Promoting Health/Preventing Disease, delineates objectives for intervention in 15 health priority areas. Approximately one-third of the objectives relate directly to the health of children, and many are addressed by a comprehensive cardiovascular (CV) health promotion program for elementary school children--Heart Smart. Priority areas addressed by this program are high blood pressure control, nutrition, fluoridation and dental health, smoking, misuse of alcohol and drugs, physical fitness and exercise, and control of stress and violence. Heart Smart is a cognitive behavioral intervention designed to address health enabling and reinforcing factors within the school environment. It is based on data from the Bogalusa Heart Study which clearly document the need for CV health intervention beginning early in life. Heart Smart includes a longitudinal classroom curriculum, an aerobic fitness program taught within physical education classes, a school lunch program offering CV healthy foods, and a teacher staff development program. The goal is to reduce CV risk factors in children. With health-enhancing behavior change of the students, family, and elementary school staff, objectives for CV risk reduction in our nation can be achieved.
School health education is generally regarded as instructional programs for students. Such programs have limited impact, especially when the social environment is inconsistent with instructional messages. A study of Oregon school districts reveals that some school personnel have gone beyond curricula in their school education programs. Exemplary districts addressed noninstructional issues, most notably staff development programs and food service offerings. In doing so, they have changed not only the social context of the schools, but their ability to directly influence a greater number of Health Objectives for the Nation.
American farmers are a specific population with specific health concerns, and there is little in the literature that addresses nursing care of farmers. The farmer needs to be educated and assessed for the potential of poisoning injury related to pesticide exposure. Studies done by the National Cancer Institute (NCI) and others have shown a somewhat greater risk of specific cancers in farmers using pesticides. Acute exposures and chronic conditions resulting from years of exposure to pesticides are oftentimes not attributed to pesticides. By use of the nursing process, nurses can develop programs at all levels of prevention to deal with this problem. This article describes such programs, as well as providing resources useful in their development.
In-depth interviews with 65 women in treatment contributed to a taxonomy of indicators of women's alcohol problems, with five major categories and numerous subcategories. The largest number of client indicators appeared in the Individual (psychological and behavioral) category. The Physiological category included unique indicators regarding physical appearance. Within the Social category, family/partner relationships were emphasized. The taxonomy can be useful in therapeutic assessments, to develop survey items, in comparative research, or in alcohol program development.
This article reviews empirically validated psychosocial treatments for posttraumatic stress disorder (PTSD) and considers factors associated with successful therapy outcome. Most of the treatments whose efficacy was studied empirically fall within the broad category of cognitive-behavioral therapy. These include exposure therapy, anxiety management programs, and cognitive therapy. These therapy modalities have been developed to modify conditioned fear and erroneous cognitions that are thought to underlie PTSD. Exposure therapy has the most empirical support because it was found to be effective across different populations of trauma victims with PTSD. Combinations of therapies have also been used, and the value of these is discussed. In addition, this article presents recent evidence about the efficacy of eye movement and desensitization reprocessing. A growing body of evidence supports the use of psychosocial treatments for PTSD, but not all patients benefit. Future research should develop programs that increase the motivation of patients to take advantage of these efficacious treatments.
World-class supply management organizations like Honda of America, John Deere, Chrysler, Hewlett Packard, and Motorola all understand the power of continuous improvement in the supply base. The best supplier management and development programs help suppliers--on a long-term basis--develop their own strength and expertise in suggestion systems, new product development, and high quality production results.
The advent of cheap and powerful micros has opened the possibility of computer-assisted learning (CAL) in medical education. This article attempts to demonstrate the educational value of CAL, with illustrations of its use. Four styles of CAL are examined, and the danger of trivializing the learning process discussed. The ultimate CAL package which enables students to take charge of their own learning is considered. There are considerable advantages in distance learning, self-assessment, computer-marked examinations and 'audit'. Some of the main problems are considered; these are decisions which must be taken about the choice of hardware and software. The use of various peripheral devices such as slide projectors and videodisc players greatly enhances the value of CAL material, as do alternative input devices. Some thought is given to software style in the presentation of material, and also to the question of the keeping of student records. The use of an author language facilitates program development, and the construction of content-free 'shell' programs enables new material to be added to existing frameworks. Other advantages of CAL include student access to JANET and the possibility of on-line searching of databases. CAL in medical education can help to liberate students from the burden of the rote learning of facts, and enhance the role of reason and imagination in the learning process.
Heart failure is a prevalent chronic condition with increasingly high rates of mortality and morbidity, frequent exacerbations, and multiple hospitalizations. The financial impact of this disease is staggering, with more than $10 billion spent annually. This article describes a heart failure service that provides five essential components of integrated care management for heart failure patients across the continuum. The program may serve as a model to others in developing programs to meet the unique needs of heart failure patients and patients with chronic diseases.